Disabilities Of Arm, Shoulder And Hand Research Articles

Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain

Study DesignCross-sectional. IntroductionPain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. Purpose of the studyThe purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. MethodsMeasures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. ResultsThe best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P < .01) included MPI Pain Interference (β = −0.54), Life Control (β = −0.16), Purdue pegboard scores (β = −0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R2 = 0.67, P < .01). ConclusionPain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.

Comparison of emergency versus selective surgical operations for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females

Objective To compare the functional outcomes between emergency operation and delayed selective operation for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females. Methods Included for this study were 60 elderly female patients who had been treated at Department of Orthopedic Trauma, The Second People's Hospital of Shenzhen from March 2016 to March 2017 for extra-articular fractures of the dorsally displaced distal radius with a volar locking plate. They were all female, aged from 65 to 80 years (average, 73.8 years). Of them, 30 received surgical operation on the day or the next day after injury (emergency group) and the other 30 did 5 to 15 days after surgery (mean, 8 days) (selective group). Follow-ups were conducted at 4, 12 and 48 weeks after surgery to assess the ranges of motion (ROMs) of the wrist and forearm, grip strength (GS), the Disability of Arm, Shoulder and Hand (DASH) scores and complications. Results The 2 groups were comparable because there were no signifi-cant differences between them in their preoperative general data (P>0.05). A 4 weeks after operation, the ROMs, GS and DASH scores were all significantly improved in both groups, but the ROM of dorsal extension (49.6°±4.1°), ROM of volar flexion (58.6°±3.5°), ROM of supination (78.1°±7.5°), ROM of pronation (81.4°±7.0°), GS (58.5%±11.2%) and DASH scores (17.3±7.9) in the emergency group were all sig-nificantly better than those in the selective group (37.0°±6.3°, 45.1°±3.6°, 70.7°±9.6°, 67.1°±10.3°, 37.3%±9.1% and 32.5±9.6, respectively) (all P 0.05). At 48 weeks after op-eration, there were no significant differences between the 2 groups in ROMs, GS or DASH scores (P>0.05). Postoperatively, superficial infection happened in one case and the extensor pollicis longus muscle tendon was ruptured in another in the emergency group. Conclusion In the elderly women with dorsally displaced extra-articular fracture of the distal radius, emergency surgery with a volar locking plate may lead to better functional recovery within 12 weeks post-surgery than the elective or delayed surgery. Key words: Wrist joint; Humeral fracture; Fracture fixation, internal; Bone plate

Positive effects of neuromuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome – A randomised controlled trial

BackgroundThe aim was to investigate the effect of Electromyography (EMG)-biofeedback guided exercises (BIONEX) on shoulder pain and function in participants with subacromial pain syndrome (SPS). MethodsTwenty-five women and 24 men (19–67 years), diagnosed with SPS, were randomised to BIONEX or the same exercises without EMG-biofeedback (NEX). Primary outcome was shoulder pain during the past 7 days (Numeric Pain Rating Scale (NPRS)). Secondary outcomes included self-reported (Disability of Arm Shoulder and Hand (DASH), Oxford Shoulder Score (OSS)), and measured shoulder function (surface EMG from upper trapezius, lower trapezius and serratus anterior) in mean and ratios of % of maximum voluntary EMG (%MVE) and onset time (msec), during arm tasks with 0, 1 and 3 kg. ResultsThere was no group difference (BIONEX versus NEX) in changed shoulder pain (NPRS, mean difference 0.18 (95% CI. −1.56; 1.19)), self-reported or measured shoulder function. Both groups, however, showed significant within-group improvements on self-reported outcomes (NPRS, DASH, OSS), only clinically relevant on NPRS (BIONEX 2.23 (SD 2.47); NEX 2.04 (SD 2.29)). ConclusionBIONEX and NEX were both effective in reducing pain to a clinically relevant level, while EMG-biofeedback did not make a difference. The current neuromuscular shoulder exercise protocol is recommended.

Combined Platelet Rich Plasma Intra-articular Shoulder Injection and Stellate Ganglion block, A new Technique for Management of Chronic Post-mastectomy Shoulder Pain Syndrome: A randomized Controlled Trial.

Background: Adhesive capsulitis of the shoulder is common after breast cancer treatment. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain. Methods: A prospective randomized open blinded end-point pilot study was conducted in a university-affiliated oncology center during the period from August 2017 till April 2018. Sixty four patients with chronic post-mastectomy frozen shoulder were enrolled and allocated into one of two groups. Group A received ultrasound guided SGB with ketamine (0.5mg/kg) plus 5ml bupivacaine 0.5% and group B received ultrasound guided SGB using ketamine and bupivacaine in the same dose as group A plus posterior approach shoulder injection with PRP. Numerical rating scale (NRS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded. T-test and ANOVA test (for parametric data) and Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test (for non-parametric data) were used for analysis. Results: Group B showed statistically significant improvement in NRS with shoulder movement and DASH score at one, two and three months after injection in comparison to group A (P≤0.001). Also, ROM improved significantly with PRP shoulder injection after one month from injection. Conclusion: The combination of intra-articular PRP injection with SGB using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia.

A study on management of tennis elbow by local platelet rich plasma injection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lateral epicondylitis (tennis elbow), a familiar term used to describe myriad symptoms around the lateral aspect of the elbow can occur during activities that require repetitive supination and pronation of the forearm with the elbow in near full extension. This condition can cause severe discomfort to the patient resulting in debilitation and impairment of routine activities. The purpose of this study was to evaluate the effectiveness of local autologous platelet rich plasma injection in the treatment of tennis elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study conducted on 50 patients of either sex with an average age of 45.92 years, presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, NUH, Haryana between November 2016 and February 2018, with a diagnosis of lateral epicondylitis. All the patients were treated with local platelet rich plasma injection and the results were analysed through the assessment of visual analog score (VAS) and disability of arm shoulder and hand (DASH) score. The patients were followed up for a period of 6 months after the local injection of platelet rich plasma.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of the patients had significant relief with this method. The VAS and DASH score improved from the pre-treatment values of 8.7 and 74.6 to 2.6 and 29.8 respectively, which was found to be statistically significant (p&amp;lt;0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus results of our study demonstrate that the local injection of platelet rich plasma is a safe and effective method of treatment of lateral epicondylitis.&lt;/p&gt;

Motor unit number index (MUNIX) in the quantitative assessment of severity and surgical outcome in cervical spondylotic amyotrophy

ObjectiveTo assess the feasibility of motor unit number index (MUNIX) in the quantitative assessment of the cervical spondylotic amyotrophy (CSA). MethodsMUNIX was recorded bilaterally on the abductor pollicis brevis, abductor digiti minimi, biceps brachii and middle deltoid in 41 normal controls and 47 patients with CSA (distal-type to proximal-type ratio: 25 to 22). Additionally, patients were assessed on handgrip strength (HGS), the disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales. These examinations were re-evaluated approximately 18 months after surgery in 37 of these CSA patients. ResultsMUNIX values were noticeably lower in the mainly affected muscles of CSA patients than those in controls (P < 0.05), and 49.0% (51/104) of the tested muscles with abnormal MUNIX measurements showed normal muscle strength. Significant correlations between MUNIX measurements and both DASH and MRC scores were observed in both CSA patient groups (P < 0.05). Postoperative longitudinal follow-up analysis identified significant increase in motor unit number in both CSA patient groups within approximately 18 months (P < 0.05), with or without improved measures of motor function. ConclusionsA significant reduction in MUNIX values related to motor impairment was observed in CSA patients, even in the subclinical stage. Compared to measures of motor function, the MUNIX measurements in the patients with CSA improved more noticeably after surgical intervention. SignificanceMUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction in CSA and to track its progression, that is complementary to conventional electromyography.

Reliability and validity of Turkish version of Lymphedema Life Impact Scale.

In this study, we aimed to investigate the validity and reliability of the Turkish adaptation of the Lymphedema Life Impact Scale (LLIS). A total of 106 patients (103 females, 3 males; mean age 53.6±11.8 years; range, 28 to 83 years) with lymphedema who were admitted to the lymphedema outpatient clinics of our hospital between May 2016 and November 2016 were included. Reliability of the scale was assessed by internal consistency (Cronbach's alpha coefficient) and test-retest method. Validity of the scale was examined using the factor analysis and correlating the 12-Item Short-Form Health Survey (SF-12), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), Disabilities of Arm Shoulder and Hand (DASH), and the Lower Extremity Functional Scale (LEFS). For internal consistency, Cronbach's alpha coefficients of all subscales ranged between 0.771 and 0.865 and calculated as 0.916 as the total score. In test-retest reliability, the correlation coefficient ranged between 0.963 and 0.985 for each subscale and calculated as 0.991 for the total score. In the validity analysis, factor analysis demonstrated a probable structure of three factors which together explained 58.9% of total variance and the Turkish adaptation of the LLIS correlated with other comparison measures used in this study. This study shows that the Turkish version of the LLIS is a valid and reliable scale to evaluate the quality of life in the Turkish population with lymphedema.

Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.&lt;/p&gt;

Evaluating neurological injury in Hirayama disease using threshold tracking technology

Objective To investigate the efficacy of neurological injury in patients with Hirayama disease using threshold tracking technique. Methods This study included 17 patients with Hirayama disease who visited the Department of Orthopaedics of Huashan Hospital from June 2017 to October 2017 (patient group, 16 males and 1 female, the average age was 18.06±0.50 years, ranging from 16 to 22 years, the average course of disease was 27.2±18.81 months, ranging from 1 to 60 months. Meanwhile, a total of 20 healthy volunteers (control group, 19 males and 1 female, the average age is 20.05±1.30 years, ranging from 17 to 23 years) were also enrolled in this study. In patient group, the median motor nerve conduction examination, needle EMG examination, and threshold tracking examination were performed on the severe side; while in control group, the median motor nerve conduction examination and threshold tracking examination were performed on either side. We evaluate the changes in peripheral motor nerve conduction of Hirayama disease by comparing CMAP (compound muscle action potential) and median motor nerve conduction velocity evaluate the changes in motor nerve excitability by comparing the rheobase, SDTC (Strength-duration time constant), threshold electrotonus, current-threshold I/V slope, superexcitability, and subexcitability. The upper limb function was assessed by disabilities of arm, shoulder and hand (DASH) score. The differences in threshold tracking parameters between groups were compared by independent t test, and the correlation between SDTC and DASH score was tested by Pearson correlation analysis. Results In the peripheral motor nerve conduction examination, the median nerve CMAP in patients with Hirayama disease was 4.12±1.43 mV in average, which is lower than healthy controls 8.23±1.61 mV (t=-3.8, P<0.01). There was no significant difference in the peripheral motor nerve conduction velocity (t=-0.86, P=0.39). In the threshold tracking examination, SDTC in patients with Hirayama disease was 0.48±0.09 ms, which was prolonged than healthy controls 0.39±0.06 ms (t=3.75, P<0.01). The absolute values of TEh (10-20) and TEh (20-40) decreased significantly (P<0.01), hence, the hyperpolarized part of the threshold-electrotonus curve showed fanning-in pattern. The slope of the current-threshold (I/V) curve had a decreasing trend. The hyperpolarized I/V slope in patients with Hirayama disease was 0.27±0.09 in average, which was lower than the healthy controls which was 0.34±0.07 (t=-2.73, P=0.01). The DASH score of patients ranged from 0.86 to 19.44, with an average of 6.99±5.79. There was a correlation between SDTC and DASH score, R2=0.36, which met the F test (P=0.01). Conclusion Threshold tracking technique can be adapted in evaluating nerve injury in Hirayama disease to determine the degree of injury and potential pathogenesis. Key words: Cervical vertebrae; Spinal cord compression; Upper extremity; Muscular atrophy; Spinal fusion; Electromyography

Cross-cultural adaptation and measurement properties of the Nepali version of the DASH (disability of arm, shoulder and hand) in patients with shoulder pain

BackgroundPatient-reported outcome measures (PROMs) are important tools in both clinical practice and research. However, no upper extremity PROM to assess physical disability is available in Nepali. The most commonly used and recommended questionnaire for the shoulder is the Disability of Arm, Shoulder and Hand (DASH). Therefore, the aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties.MethodsThe translation and cultural adaptation process followed international standard procedures. The translated Nepali version of the questionnaire (DASH-NP) was completed by 156 patients with shoulder pain from three Nepali hospitals at an initial assessment and by 121 at follow-up. A Nepali version of Global Rating of Change (GROC-NP) was completed at follow-up to dichotomise improved and stable participants. Measurement properties testing included: internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient, ICC), Minimal Detectable Change (MDC), construct validity - factor analysis, hypothesis testing with the Shoulder Pain and Disability Index (SPADI) (Pearson Correlation = r) and responsiveness - Area Under the Curve with minimal important change.ResultsSignificant adaptations such as changing measurement units, activities and terminology were incorporated to improve cultural relevance. Internal consistency (α = 0.92) and test-retest reliability (ICC = 0.97, 95% CI: 0.94–0.98, p < 0.001) were excellent. The MDC was 11 out of 100 points. There were moderate-high positive correlations with the SPADI pain and disability items (rs = 0.63 and 0.81, P < 0.001). Four factor solution was retrieved for the DASH-NP. The Area Under the Curve was 0.69 (95% CI: 0.57 - 0.81, p < 0.001) with minimal important change of 11.2/100 points.ConclusionsThe Nepali translation of the DASH is comprehensible, easy to administer via self-report or interview. It is found to be a reliable, valid, and responsive measure in patients with shoulder pain in Nepal. The DASH-NP can be used to assess shoulder pain related disability in Nepal for clinical practice or research.

Salvage of failed trapeziectomy, ligament reconstruction and tendon interposition with suture button suspensionplasty for basilar joint arthritis

Background: Thumb basilar joint arthritis is a common pathology treated by hand surgeons. Trapeziectomy followed by various reconstructive techniques have been described; however, treatment options after failed primary trapeziectomy and ligament reconstruction (LRTI) with painful subsidence are not well studied. Suture button suspensionplasty has emerged as a new primary reconstructive procedure in recent years. We aim to report our experience of using suture button suspensionplasty as a salvage procedure for patients presenting with recurrent painful subsidence after primary surgical intervention. Methods: A retrospective chart review of all patients undergoing suture button suspensionplasty between 2016-2017 was performed. Patients who had the procedure after failed primary trapeziectomy and LRTI were included in the study. Patient demographic data, diagnostic imaging, clinical presentation, operative details, surgical pathology, and clinical outcomes were reviewed. Results: Thirty-two button suspensionplasties were performed in the 2-year span. Five patients underwent surgery for failure of previous trapeziectomy with ligament reconstruction. All patients had Eaton stage III arthritis at original presentation. The average age was 59 yr. Average follow-up was 13 mo (11-18 mo). All patients reported significant improvement in pain and hand function after revision surgery. One patient had a second revision surgery because of failure of the first revision secondary to a fall. Postoperative Disabilities of Arm Shoulder and Hand (DASH) score range from 13.3 to 25, with an average of 19.8. Conclusions: Suture button suspensionplasty is a viable option for patients who present with painful subsidence after failure of primary surgical intervention for basilar joint arthritis.

Stenosing tenosynovitis : Evaluation of percutaneous release with a specially designed needle vs. open surgery.

The purpose of this study was to evaluate the effectiveness of conventional open surgery and percutaneous release with aspecially designed needle for treating stenosing tenosynovitis in terms of cure, relapse and complication rates. In this study 89fingers from 76patients were randomly assigned and allocated to one of the treatment groups. Atotal of 37patients were treated with open surgery in group1 and 39patients with percutaneous release using a specially designed needle in group2. Apatient-based 4-inch visual analogue scale (VAS), Quinnell grading (QG), disability of arm shoulder and hand (DASH) score and finger total joint range of motion (FTROM) score were evaluated before treatment and after 7, 30 and 180days. When finger QG scores were equal or greater than 2points at follow-up at 180days this was defined as recurrence.. There were no significant differences between the two groups (P > 0.05) in terms of VAS, DASH and QG scores and the degree of FTROM. At 7days all the data were significantly different (p < 0.05) compared with preoperative data, 30 days was significantly different (p < 0.05) compared with 7 days while at 180 days no significant differences could be found (p > 0.05) compared with 30 days. The recurrence rate in group1 was 4.65% and 6.55% in group2. The percutaneous release and open surgery methods displayed similar effectiveness regarding the cure and recurrence of trigger finger disorder. The use of a specially designed needle for release is asafe and reliable method.

In intra-articular distal humeral fractures: Can combined medial-lateral approach gain better outcomes than olecranon osteotomy?

This research aimed to evaluate the functional outcomes of intra-articular distal humeral fractures treated through a combined medial-lateral approach and comparing with olecranon osteotomy simultaneously. In this study, 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10-24 months) for a combined medial-lateral group and 14.6±2.6 months (range 10-20 months) for olecranon osteotomy. Level, retrospective study. The flexion-extension of elbows was 115.3°±16.1° in the combined medial-lateral group, and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion-extension of the elbows (p=0.041). Pronation-supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences were not noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005). The combined medial-lateral approach is successful approach in the treatment of intra-articular distal humeral fractures (especially type C1 and C2) that provides better outcomes for the motion of the elbow, bleeding volume in surgery and complications than olecranon osteotomy.

Grip strength following total wrist arthrodesis using the same hand as reference: a prospective study

Introduction: Many patients suffer from a decrease in grip strength due to various conditions of the wrist, including osteoarthritis. A stable painless wrist is essential for normal function of the hand. Many patients are offered a total wrist fusion to alleviate their pain and increase their grip. There is a dearth of literature investigating the effect of total wrist arthrodesis on grip strength utilising the same side as a reference. Methods: A prospective study was done to determine change in grip strength and patient-reported outcome measurements postoperatively as compared to same-side pre-operative values in subjects undergoing total wrist arthrodesis with a minimum follow-up of one year. Grip strength was measured pre-operatively and at least one year post-operatively using the Jamar® (Patterson Medical) dynamometer in the standardised method as part of set protocol. Functional outcomes were assessed by the patients completing Disabilities of Arm, Shoulder and Hand (DASH) scores, pre-operatively and at one-year follow-up. The differences in measures were assessed using a paired samples T-test, as well as percentage changes between measurements. Results: Twenty-two patients were evaluated, with a mean age of 49.6 years (range 19–85). The mean follow-up was 27 months (12–52 months). The grip strength in the affected hand improved on average by 12.6 kg (p<0.001; CI 95% [7.7, 17.3]). The grip in the affected hand was 84.5% compared to the pre-operative value of the unaffected side (32.8 kg vs 38.8 kg; p<0.001). The DASH score improved by 27.8 points (p=0.1). Conclusion: Total wrist fusion remains a reliable procedure to restore a power grip at the expense of wrist movement. It is a suitable option for a high-demand patient with an isolated wrist problem. Level of evidence: Level 3

Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series

IntroductionRadial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. However, our knowledge about the long-term functional outcomes of treating RCH is limited. In current study, we investigated the outcomes of centralization and pollicization using second or third metacarpal bone in RCH patients. MethodsThere were 15 hands (13 patients) with RCH underwent centralization and pollicization using second or third metacarpal bone or tendon transfer. The patients aged 1.2 ± 1 years at the time of the surgery. On early postoperative x-rays, the forearm-hand angle was measured. The patients were followed for 6.2 ± 2.3 years. At the final visit, disabilities of arm, shoulder and hand (DASH) score was completed. Furthermore, forearm-hand angle and range of motion of both wrists in sagittal and coronal planes were measured. ResultsThe mean of forearm-hand angle increased significantly. In 11 wrists, forearm-hand angle increased only 10 degrees of less. The range of operated wrist was improved in sagittal and coronal planes. The relative range of wrist motion in patients with unilateral deformity in sagittal and coronal planes was 83 ± 11 percent and 61 ± 12 percent. Three patients developed skin necrosis. ConclusionEarly centralization and pollicization using second or third metacarpal bone can significantly restore the range of motion and function in patients with RCH.

Linking of Items in Two Function-related Questionnaires to the International Classification of Functioning, Disability and Health: Shoulder Pain

Purpose: This study was to identify international classification of functioning, disability and health (ICF) categories that could be linked conceptually to disability of arm, shoulder and hand (DASH) items and short form of health survey 36 (SF-36) items for persons with shoulder pain. Methods: Linkage between each item in DASH and SF-36 and the categories in the ICF were assessed. The linking process was performed by ten health professionals following the linking rule. One hundred four patients with shoulder pain were enrolled from 12 private clinic outpatient departments and participated in this study. Pearson correlation coefficients were used to assess the relationships between each scale item and the linked ICF code. Results: Thirty DASH items were able to be linked to 30 ICF codes, whereas the 36 items in SF-36 were only linked to 17 ICF codes. General health items included in SF-36 could not be linked to a relevant ICF concept. There was a high correlation between the two measurement tools and the linked ICF codes, DASH and its ICF code list (r =0.91), SF-36-Physical Health and its code list (r =-0.62), and SF- 36-Mental Health and its code list (r =-0.72). Conclusion: The results suggest that concepts within each item in DASH can be linked to ICF codes for patients with shoulder pain, however, the concepts in the SF-36 items had limited linkage to ICF codes. The shoulder-specific functional tool, DASH can be expressed with ICF codes and, therefore, its use can promote data standardization and improve communication between professionals.

Patient-reported outcomes of carpal tunnel syndrome surgery in a non-industrial area.

This study aimed to determine the environmental conditions for the occurrence of carpal tunnel syndrome (CTS) in a non-industrial area, and patient-reported outcomes after surgical release. This observational study utilized convenience sampling to screen 100 consecutive patients for carpal tunnel syndrome at the Orthopedic Clinic, using two questionnaires. Data were collected from the Disability of Arm Shoulder and Hand (DASH) questionnaire, and the PROMIS® (Patient-Reported Outcomes Measurement Information System) Upper Extremity and PROMIS® SF 3a questionnaire (Pain Intensity). The relationship of various repetitive musculoskeletal disorders to CTS was validated by questionnaire scores, PROMIS® T-score, and correlation coefficients. Finally, CTS was confirmed by electromyography in 69 patients (55 females and 14 males; average age: 47.5 years). Aging significantly influenced the occurrence of symptoms associated with pain (neck, thoracic, lower back, shoulder, and CTS (p<0.001)). Those employed for longer more frequently declared performing exercises to prevent overload pain (p<0.001). DASH results significantly correlated with the PROMIS Upper Extremity score (r = -0.64; p<0.05). Geographical and environmental conditions indicate that even though working with a computer is described as an essential risk factor for CTS, the study group showed a predominance of elements that were unrelated to working at a computer. CTS also occurred among people working physically, and even among unemployed individuals. The existence of a statistically significant, strong, negative correlation (r=-0.64; p < 0.05) between the results obtained in the questionnaires DASH and PROMIS Upper Extremity has been demonstrated.

One portal endoscopic release of the first extensor compartment in de Quervain's disease

ObjectivesWe aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method. Materials and methodsThe patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. ResultsThe mean operating time was 13.9 min (range, 10–21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation. ConclusionsOne portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. Level of EvidenceLevel IV Therapeutic Study

Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study

The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded. The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex-Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively. The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient's radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499-505.

Functional outcome of surgical management of fracture both bones forearm in adults using LC-DCP

Background: Forearm bone fractures are commonly encountered in today’s industrial era due to road traffic accidents, contact atheletic participation and falls from a height. Treatment by closed reduction and cast immobilization risks a poor functional outcome with unsatisfactory results reported in up to 92% of cases, usually caused by malunion, nonunion, or synostosis. Open reduction and internal fixation with plating is generally accepted as the best method of treatment for displaced diaphyseal fractures of the forearm in the adult. This study will be conducted to analyze diaphyseal fractures of the forearm treated with limited contact dynamic compression plate and will document their clinical and functional outcome. Materials and Methods: A prospective, non-controlled, non-randomized, non-blinded observational study, on patients with diaphyseal fractures of both bone forearm admitted in Department of Orthopaedics, RIMS, Ranchi during two years time interval (from 1st October 2015 to 30thSeptember 2017) in the age group of 19 to 70 years with a mean age of 36.29 years was conducted. 53 Patients were selected for the study from those presenting to our hospital. The outcome was assessed based the disabilities of arm; shoulder and hand (DASH) score. Results: Results were analysed according to disabilities of arm; shoulder and hand (DASH) score. Excellent functional outcome result in 40 patients (80%), satisfactory in 5 patients (10%) while remaining had fair to poor outcome. Mean final DASH score of 23.99 was recorded among the study group. Maximum number of patients had no complication, complication like superficial infection were reported among few patients. Despite these complication the overall functional result was good; suggesting that open reduction and internal fixation with limited contact dynamic compression plate (LC -DCP) is an effective treatment modality in these fractures. Conclusion: Open reduction and internal fixation with limited contact dynamic compression plate (LC-DCP) is an effective method of treatment for AO type A3, B3 and type C both bone forearm fracture. This implant is particularly helpful in osteoporotic bones.